Hospital quality indicator may not be linked to patient survival after colon canc...(n rates and survival after surgery. Alth...),Health

Date:11/13/2007

n rates and survival after surgery. Although the four hospital groups varied widely in the number of lymph nodes examined, they were equally likely to find node-positive tumors. There were no clinically important differences in the use of adjuvant chemotherapy, either overall (unadjusted rates of 26 percent for the highest hospital quartile vs. 25 percent for the lowest hospital quartile) or within cancer stage subgroups.

Our study raises questions about the importance of examining a large number of lymph nodes in patients with colon cancer, the authors write.

Regarding the finding of no evidence of higher 5-year survival at hospitals with higher lymph node examination rates: Our analyses also suggest a simple explanation for these null findings. Regardless of how many lymph nodes hospitals examined, they tended to find the same number of node-positive ones. As a result, higher hospital lymph node examination rates did not result in greater detection of patients with node-positive tumors or higher rates of adjuvant chemotherapy.

Using lymph node counts as a hospital quality indicator is gaining momentum from stakeholders in the health care community, the researchers write. The number of lymph nodes hospitals examine following colectomy for colon cancer is not associated with staging, use of adjuvant chemotherapy, or patient survival. Efforts by payers and professional organizations to increase node examination rates may have limited value as a public health intervention.

(JAMA. 2007;298(18):2149-2154. Available pre-embargo to the media at www.jamamedia.org)

Editors Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Editorial: Lymph Node Counts in Colon Cancer Surgery - Lessons for Users of Quality Indicators

In an accompanying edi
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Contact: Mary Beth Reilly 734-764-2220 JAMA and Archives Journals Source:Eurekalert

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